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�oaga u o SAN JOAQUIN COUNTY <br /> LTA �z ENVIRONMENTAL HEALTH DEPARTMENT <br /> "= 1868 East Hazelton Avenue, Stockton, CA 95202-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.or /q ehd <br /> HOTEL/MOTEL OFFICIAL INSPECTION REPORT <br /> Name of Facility: Inspection Date: <br /> M vtcl - 13�3 z_ct: <br /> Address: r 7 �� PE: PR#: ,. <br /> Noel <br /> Owner/Operator: Phone: <br /> 1%.Sc' <br /> IX Annual Inspection ❑ Complaint Inspection ❑ Consultation Inspection ❑ Re-Inspection <br /> #Units in Facility: & I #Units Inspected: 1'2- 1 Reinspection On or About: <br /> The items checked below are violations to be corrected. <br /> See Reverse Side of this Form for Detailed Summary of Violations and Code References. Room(s): <br /> ❑ Room Cleanliness: Lack of cleanliness&sanitation;Accumulation of debris,trash, <br /> garbage,combustible items or similar materials. <br /> Room Maintenance: General lack of repair or improper maintenance; Broken or non- <br /> 2' <br /> functioning sink/toilet/bath; Lack of hot water. Floors: Not clean, properly covered or in -meq S;WJOr 64f'&-e <br /> good repair.Walls&Ceilings:Walls/ceilings in need of cleaning or repair: Holes,water ;i ZL4 /aCr I(-sZ <br /> damage, peeling or deteriorating paint; Dampness or excessive moisture in room. -Z3 C41c" w <br /> ❑ Heating: Lack of approved heating in each unit;Approved heater not maintained in a safe, <br /> 3' working condition; Lack of adequate heat(Standard:70°F at 3 feet from floor). <br /> Drinking Utensils&Ice Buckets:Not protected from contamination; Lack of or improper <br /> ❑ 4. washing &sanitizing after each use(multi-use); Lack of or improper protective bagging <br /> (multi-use)or individual protective wrapping (single-use). <br /> ❑ 5 Bedding: Mattress/linens infested with lice, bedbugs,or other insects; Not free from filth or <br /> foul matter; Unsafe; Linens not changed weekly or before new guest. <br /> F-1 6 Garbage Receptacles: Inadequate number of garbage receptacles; Lack of or inadequate <br /> close fitting covers; Garbage receptacles unclean or in disrepair. <br /> ❑ 7 Public Areas: Unsafe or unsanitary conditions in kitchen, hallways,stairways,exits,or other <br /> publicly shared spaces. <br /> ❑ 8. Pest Control: Infestation of insects,vermin or rodents. <br /> ❑ 9. Other Nuisance:Any other condition which is hazardous to health. <br /> Other Substandard or Unsafe Conditions: Electrical, structural,or plumbing hazards; Lack 26/ z?9 �`r �I' n <br /> to. of or inadequate smoke detectors or fire extinguishers; Inadequate lighting; Inadequate i1 . rf- Pxb,jA14, .6 <br /> protection from weather; Inadequate sewage or water facilities. all <br /> Pest control Used? X Yes ❑ No Company Name: r�; -�r 4- Frequency: ej, / <br /> Hotel/Motel Business License? X Yes ❑ No 2u <br /> Multi-Jurisdictional Violations to be Referred to: ❑ City Building/Code Enforcement/Fire❑ County Code Enforcement/Fire❑ Other <br /> Rooms inspected: Z Cy,, 4 3 Z 3 tl 2z ll :Y75 ZjS/ Z,C" G <br /> Comments: _ c yirn�,M ,r>��t cc�'yY�'a 3zsr` SircG•rf trC �� <br /> -X 4p(ul ccu2 IC&P Vl 1't <br /> All violations in rooms not inspected must also be corrected. <br /> All r pections by th - nvironmental Health Department will be billed at the current hourly rate. <br /> Received By: �qy& Title: <br /> Environmental alth tial jljiA— _ Phone: i / Page 1 of <br /> EHD 24-01 4-30-12 HOTEUMOTEL OR <br />